From the Guidelines
Nasal polyps can regress with steroid nasal sprays, which are often the first-line treatment for this condition, as supported by high-quality evidence from studies such as the european position paper on rhinosinusitis and nasal polyps 2020 1. Medications like fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort), and triamcinolone (Nasacort) are commonly prescribed. Some key points to consider when using steroid nasal sprays for nasal polyps include:
- Patients typically use 1-2 sprays in each nostril once or twice daily, depending on the specific medication and severity of polyps.
- For best results, the spray should be used consistently for at least 4-6 weeks before evaluating effectiveness, though some improvement may be noticed earlier, as seen in studies such as Demirel 2008 1 and Lildholdt 1995 1.
- Proper technique is crucial: shake the bottle, keep your head upright, direct the spray away from the septum, and avoid sniffing forcefully.
- Steroid sprays work by reducing inflammation in the nasal tissues, which shrinks the polyps by decreasing the fluid content and cellular infiltration.
- While many patients experience significant reduction in polyp size and associated symptoms (congestion, runny nose, loss of smell), complete resolution occurs in only about 20-30% of cases, as noted in the european position paper on rhinosinusitis and nasal polyps 2020 1.
- Larger polyps may require oral steroids or surgery before maintenance with nasal sprays.
- Side effects are generally mild and may include local irritation, nosebleeds, or headache, as reported in studies such as Johansen 1993 1 and Qvarnberg 1992 1. The use of nasal corticosteroids is supported by high-quality evidence, with a significant impact on nasal symptoms and quality of life improvement, although the effect on SNOT-22 is smaller than the minimal clinically important difference, as stated in the european position paper on rhinosinusitis and nasal polyps 2020 1.
From the Research
Nasal Polyps Regression with Steroid Nasal Spray
- Nasal polyps can regress with the use of steroid nasal sprays, as evidenced by studies that have shown a significant reduction in polyp size and improvement in nasal symptoms 2, 3.
- A study published in The Journal of Allergy and Clinical Immunology found that mometasone furoate nasal spray (MFNS) significantly reduced polyp grade score and improved congestion, loss of smell, anterior rhinorrhea, and postnasal drip in patients with nasal polyposis 2.
- Another study published in The Cochrane Database of Systematic Reviews found that oral steroids provided a short-term benefit in reducing polyp size and improving nasal symptoms in patients with multiple nasal polyps, although the quality of the evidence was moderate to low 3.
- The use of steroid nasal sprays has been shown to be safe and effective in reducing polyp size and improving nasal symptoms in both adults and children 2, 4.
- Factors that may predict a favorable response to steroid treatment include a history of allergic rhinitis and low expression of glucocorticoid receptor β in the nasal polyp epithelium 5.
Mechanism of Action
- Steroid nasal sprays work by reducing inflammation and swelling in the nasal passages, which can help to shrink polyps and improve nasal symptoms 2, 6.
- The exact mechanism of action is not fully understood, but it is thought to involve the suppression of inflammatory mediators and the reduction of eosinophil infiltration in the nasal mucosa 5.
Clinical Implications
- Steroid nasal sprays may be a useful treatment option for patients with nasal polyposis, particularly those with a history of allergic rhinitis or low expression of glucocorticoid receptor β in the nasal polyp epithelium 2, 5.
- The use of steroid nasal sprays may reduce the need for surgical intervention in some patients, although further studies are needed to confirm this 2, 6.